Hepatocellular Adenoma (Hepatic Adenoma) Clinical Presentation

Updated: Dec 03, 2020
  • Author: Michael H Piper, MD; Chief Editor: BS Anand, MD  more...
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Presentation

History

The clinical presentation of hepatocellular adenoma (HCA) (hepatic adenomas) varies widely. Salient features of the history and physical examination may include the following:

  • Pain may be present in the right upper quadrant or epigastric region.

  • Patients may notice a palpable mass. Lesions may also be discovered incidentally during an abdominal imaging study for an unrelated reason.

  • History of birth control or anabolic steroid use should be elicited in patients with suspected HCAs.

  • Patients may also present with severe, acute abdominal pain with bleeding into the abdomen, which results in signs of shock (eg, hypotension, tachycardia, diaphoresis).

  • Hemoperitoneum occurs more frequently if the patient is taking a high-dose oral contraceptive pill (OCP), is actively menstruating or pregnant, or is within 6 weeks postpartum. Location of the lesion also is important, with those near the surface of the liver more prone to causing hemoperitoneum.

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Physical Examination

The physical examination findings in patients with hepatocellular adenomas (HCAs) (hepatic adenomas) are often nonspecific. Patients may be asymptomatic, or they may appear ill, with pallor and abdominal distress. Note the following:

  • Vital signs with tachycardia, hypotension, or orthostasis (concerning for active hemorrhage)

  • Anicteric sclera (jaundice has been reported due to compression of the tumor on the biliary tree)

  • Pale conjunctiva, if hemorrhage has occurred

  • Right hypochondrial mass, with or without tenderness

  • Hepatomegaly

  • Fluid wave (in cases of hemoperitoneum)

  • Peritoneal signs, including guarding or rebound in cases of tumor rupture

  • Skin findings: Grey Turner sign or Cullen sign in cases of hemoperitoneum

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